Orders for Flublok – the only flu vaccine not derived from eggs – remain well below company goals, and officials haven’t been able to get it into some major pharmacy chains such as CVS and Walgreens.
“We’re doing better than last year, but we’re still not doing as well as I would like to do,” said CEO Manon Cox.
The company aims to sell 900,000 doses of Flublok by the end of the current flu season in late March, she said. So far, it has sold just 250,000, even as widespread flu outbreaks spread across several parts of the country. In Connecticut, 791 flu cases were confirmed as of Jan. 14.
The company’s efforts have been hampered by both price and a lack of awareness about clinical data showing the vaccine’s effectiveness, Cox said. Protein Sciences claims Flublok, approved by the U.S. Food and Drug Administration in January 2013, contains three times more antigen than traditional flu vaccines and is manufactured with no antibiotics or harsh chemicals.
This year, Protein Sciences will start selling a new formulation of the vaccine that protects against four strains of influenza instead of just three. The new formulation has the potential to be a game-changer for the company, Cox said, since the vast majority of the flu shot market now is four-strain vaccines.
Getting pharmacies and doctors to stock Flublok, which carries a wholesale price tag of $35 a dose, has been a tough sell when competitors made by pharmaceutical giants such as Sanofi and GlaxoSmithKline run around $10 to $20 a dose in wholesale, she said.
Dr. Howard Selinger, chair of family medicine at Quinnipiac University’s School of Medicine and a physician partner at ProHealth Physicians in Bristol, agreed that price is a driving factor in gaining market share.
“It comes down to the business model, and that’s where they [Protein Sciences] are probably having trouble,” he said. “How cheap can they go? They’re trying to compete with the big boys.”
Large pharmaceutical companies produce many more vaccine doses than Protein Sciences, meaning they are able to get their cost per dose down significantly.
Insurance carriers often reimburse Flublok’s cost to pharmacies and physicians at a lower rate than competitors, Cox added, even as the company increases its outreach efforts to insurance companies.
Cox said large drug-makers have huge marketing budgets and can offer substantial rebates, reducing their price even further – something Protein Sciences can’t now afford to do.
“We’re a small company,” she said of the Meriden-based firm, which employs 125 workers.
Officials at CVS did not respond to requests for comment about why they don’t stock the Flublok vaccine. A spokeswoman for Walgreens, Emily Hartwig-Mekstan, said that the chain works “with a couple of suppliers to offer a number of vaccine options to meet a variety of patient needs.”
Still, Protein Sciences has gained traction among smaller, independently owned pharmacies. In Connecticut, consumers can get the Flublok vaccine at 68 locations statewide, many of which are independent pharmacies.
Such pharmacies seem to have more of a vested interest in their customers’ wellbeing than corporate-owned chains, Cox said, “so those are the ones that we’re targeting.”
Greg McKenna, manager at Higganum Pharmacy and owner of three other pharmacies, has stocked Flublok since it hit the market.
“It’s novel, and it’s a great approach,” he said. “It gives you a better level of protection.”
McKenna particularly recommends Flublok for the elderly and people who are sensitive to respiratory infections. He tries to educate customers when they want flu shots, highlighting the benefits of Flublok.
“Last year was a hard one, because a lot of insurance companies weren’t really reimbursing for it,” he said. Now, more insurance carriers are, but “not everybody is paying for it,” he said, and that’s something customers consider.
While some large pharmacy chains have shunned Flublok, others carry it: Walmart, Rite Aid, ShopRite and Stop & Shop. Protein Sciences last year struck a deal to sell 100,000 doses to Target as well, but that deal ended when CVS took over operation of Target pharmacies, Cox said.
The vaccine could gain popularity if data were more widely available on its efficacy, Selinger said. Doctors are likely to pay more for a vaccine only if it’s proven to be more effective than competitors, he said, and the medical community hasn’t been made aware of clinical data giving Flublok the edge.
“It hasn’t really hit the books that Flublok is simply better,” he said.
A study done in 2014 and 2015 among 9,000 adults ages 50 and older found those who received Flublok were 40 percent less likely to get cell culture-confirmed influenza than those with a traditional flu vaccine, according to Cox.
Cox said she’s encouraged by the progress made by the company in increasing awareness. Every major pharmacy chain and insurance carrier now knows about Flublok, she said.
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